UDkt Alex Jimenez Unikezela: Indlela I-Hypertension ichazwa ngayo

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intshayelelo

UDkt Alex Jimenez, DC, ubonisa indlela i-hypertension echaphazela ngayo umzimba womntu kunye nezizathu ezithile ezinokunyusa uxinzelelo lwegazi kubantu abaninzi kule nxalenye ye-2. Sithumela izigulana zethu kubaboneleli bezonyango abaqinisekisiweyo ababonelela ngonyango olufumanekayo oluninzi kubantu abaninzi abanengxaki yoxinzelelo lwegazi ehambelana nentliziyo kunye nenkqubo yokuzikhusela komzimba echaphazela umzimba. Sikhuthaza ngamnye kwizigulane zethu ngokuzikhankanya kubaboneleli bezonyango abanxulumeneyo ngokusekelwe kuhlalutyo lwabo ngokufanelekileyo. Siyaqonda ukuba imfundo yindlela eyonwabisayo xa ubuza ababoneleli bethu imibuzo ngokwesicelo sesigulana kunye nokuqonda kwakhe. UDkt Jimenez, DC, usebenzisa le ngcaciso kuphela njengenkonzo yemfundo. isikhanyeli

 

Ujongwa njani Uxinzelelo lwegazi

UGqr. Alex Jimenez, DC, unikezela: Masibuyele kumthi wesigqibo ukuze uqale ukucinga malunga nendlela oya kuyisebenzisa ngayo imodeli yokuya kuyo kwiyeza elisebenzayo kwi-hypertension kunye nendlela oza kuqala ngayo ukuvavanya umntu onoxinzelelo lwegazi kunokuba ubaxelele ukuba uxinzelelo lwegazi luphakanyisiwe. . Ngaba umzimba uphenjelelwa kukudumba, uxinzelelo lwe-oxidative, okanye ukuphendula kwamajoni omzimba? Ngaba ichaphazela umsebenzi we-endothelial okanye i-vascular smooth muscle evela kwezo ndidi zintathu zokuphendula, ukuvuvukala, uxinzelelo lwe-oxidative, okanye impendulo yomzimba? Ngaba sikhetha i-diuretic calcium channel blocker okanye i-ACE inhibitor? Kwaye ukwenza oko, kubaluleke kakhulu kwicandelo lethu lokuqokelela. Ukuthatha imbali yonyango kunye nexesha loxinzelelo lwegazi labo, ufumana inkcazo malunga nomonakalo welungu kwiimibuzo. Ujonge i-anthropometrics yabo.

 

Oku kuquka le mibuzo ilandelayo:

• Ziziphi iimpawu zokukrala?
• Ziziphi iimpawu zebhayoloji kunye nezalathi zeklinikhi?

 

Ezo zichazwe ngomthi wesigqibo seklinikhi. Kwaye sele usenza loo nto, uzakwandisa kwaye ulungise kakuhle ilensi yakho koko unokukubona kwisigulana sakho sehypertension. Masiyongeze kuluhlu lwexesha luqala nini uxinzelelo lwegazi? Ixesha elibekiweyo loxinzelelo lwegazi liqala ngenene ngexesha lokubeleka. Kubalulekile ukubuza isigulana sakho ukuba sikwiminyaka yokuqala okanye enkulu yokufunda. Ngaba umama wabo wayenestres? Ngaba bazalwa kwangoko okanye ngaphambi kwexesha? Ngaba bekukho uxinzelelo lwezondlo ekukhulelweni kwabo? Ukuba bayayazi loo nto, unokuba nabantu ababini abanobukhulu obufanayo bezintso, kodwa umntu obengenayo iprotein eyaneleyo ngexesha lokukhulelwa unokuba ne-glomeruli engaphantsi ngama-40%. Ukwazi oko kuya kutshintsha indlela olilungisa ngayo iyeza kumashumi eminyaka kamva ukuba uyazi ukuba banokuba ne-40% ngaphantsi kweglomeruli.

 

Uluhlu Lwexesha Loxinzelelo Lwegazi

UGqr. Alex Jimenez, DC, unikezela: Ngoko ke kubalulekile ukuthatha ixesha loxinzelelo lwegazi. Kukwabalulekile ke ukuba siqaphele ukuba kwenzeka ntoni xa siqala ukulungelelanisa nokuqokelela idatha ngokusebenzisa ii-biomarkers; i-biomarkers esisiseko iya kukunika imikhondo malunga nokuba banemiba ye-insulin lipids, nokuba baneengxaki nge-vascular reactivity, i-autonomic nervous system balance, ukungalingani, i-coagulation, okanye i-immune toxin effects. Ke le yinto esengqiqweni ukuyiprinta kuba, kwisigulana sakho esinoxinzelelo lwegazi, oku kungenxa yee-biomarkers onokuthi uqalise ukufumana umkhondo wokuba zeziphi iindawo zokungasebenzi kakuhle ezichaphazela ukudumba, uxinzelelo lwe-oxidative, kunye nokuphendula komzimba kunye nendlela ezi mpawu zebhayoloji zibonakalisa oko. ulwazi kuwe. Oku kusengqiqweni ukuba phambi kwakho ukunceda ukutshintsha iingcinga zakho malunga noxinzelelo lwegazi kwaye kukwenza ukuba usulungekise ezinye zeempawu zomntu kwelinye icala le-stethoscope yakho ngendlela eyenzelwe wena ngakumbi, echanekileyo.

 

Kodwa masiqale kwasekuqaleni. Ngaba isigulane sakho sinoxinzelelo lwegazi oluphezulu? Siyazi ukuba ngokuxhomekeke kwiziphumo zelungu lesiphelo lezinto ezidibene nazo, unokumqhubela umntu uxinzelelo lwegazi oluphezulu kancinci ukuba unomcimbi omkhulu engqondweni nasezintso okanye entliziyweni, kodwa kukho izikhokelo ezithile. Izikhokelo zethu ze-2017 American Heart Association kwiindidi zoxinzelelo lwegazi zidweliswe apha. Baye bawax kwaye bancipha emva naphambili kule minyaka imbalwa idlulileyo, kodwa oku kucace gca. Ukunyusa uxinzelelo lwegazi, nantoni na engaphezulu kwe-120, itshintshe ngokwenene ukuba bangaphi abantu esiqala ukubabona okanye sicinge ngokujongana nezona zizathu zoxinzelelo lwegazi. Ke siza kubuyela koku, ngakumbi kwimeko yokusinceda sijonge indlela esibahlula ngayo abantu abanemiba yoxinzelelo lwegazi.

 

Iikhrayitheriya zokulinganisa uxinzelelo lwegazi

UGqr. Alex Jimenez, DC, unikezela: Liliphi inyathelo lokuqala? Ngaba uthatha njani uxinzelelo lwegazi kwisigulana sakho? Ngaba bayayijonga ekhaya? Ngaba bazisa loo manani kuwe? Ulujonga njani uxinzelelo lwegazi kwikliniki yakho? Ulufumana njani ufundo oluchanekileyo kwiklinikhi yakho? Nazi iikhrayitheriya zokulinganisa ngokuchanekileyo uxinzelelo lwegazi kunye nemibuzo yokuqwalasela ukuba uyazenza zonke ezi zinto. 

• Ngaba uyasibuza isigulana sakho ukuba sikhe sinecaffeine kwiyure yokugqibela?
• Ingaba baye batshaya kwiyure edlulileyo?
• Ngaba baye bachanabeka ekutshayeni ngeyure yokugqibela? 
• Ingaba indawo othatha kuyo uxinzelelo lwegazi ifudumele kwaye izolile?
• Ngaba bahleli ngomqolo wabo esekelwe esitulweni iinyawo zabo ziphantsi?
• Ngaba usebenzisa itafile ejikelezayo ukuphumla ingalo yakho kwinqanaba lentliziyo?
• Ngaba bahleli etafileni yeemviwo iinyawo zabo zijinga, kwaye umongikazi oncedisayo uphakamisa ingalo yabo kwaye abeke kwi-axillary fold yabo ukubamba ingalo yabo apho?
• Ngaba iinyawo zabo zisemhlabeni? 
• Ngaba baye bahlala apho imizuzu emihlanu? 
• Ngaba bebezilolonga kwimizuzu engama-30 edlulileyo? 

 

Unokuba noxinzelelo lwegazi lwe-systolic ukuba yonke into ikwimilinganiselo. Nanku umceli mngeni. Kukho i-10 ukuya kwi-15 yeemilimitha ze-mercury phezulu xa kuthethwa ngokuhlala kunye nokuthatha uxinzelelo lwegazi. Kuthekani ngobungakanani bekhafu? Siyazi kwinkulungwane edlulileyo; abantu abadala abaninzi babenengalo engaphezulu yesangqa esingaphantsi kweesentimitha ezingama-33. Ngaphezulu kwe-61% yabantu ngoku banesangqa sengalo ephezulu ngaphezulu kwama-33 eesentimitha. Ke ubukhulu becuff buhlukile malunga ne-60% yezigulane zakho zabantu abadala, kuxhomekeke kuluntu lwakho. Ngoko kufuneka usebenzise i-cuff enkulu. Ngoko jonga indlela uxinzelelo lwegazi oluqokelelwa ngayo kwiofisi yakho. Masithi uxinzelelo lwegazi lunyukile kwizigulana zakho; ke kufuneka sibuze, iqhelekile? Kakhulu.

 

Iindidi ezahlukeneyo zoxinzelelo lwegazi

UGqr. Alex Jimenez, DC, unikezela: Ngaba iphakanyisiwe ngenxa yoxinzelelo lwegazi olumhlophe? Ngaba banoxinzelelo lwegazi oluqhelekileyo, olunyuswe ngaphandle kwekliniki, okanye uxinzelelo lwegazi olugqunyiweyo? Okanye ngaba banoxinzelelo lwegazi oluzinzileyo olulucelomngeni? Siza kuthetha ngaloo nto. Ke xa utolika, kubalulekile ukuba uthathele ingqalelo i-ambulatory blood pressure monitoring. Ke ukuba unomntu onoxinzelelo lwegazi kwaye awazi ukuba uxinzelelo lwegazi luyehla kwaye uzama ukufumanisa ukuba ngaba lugcinwe luxinzelelo lwegazi, ungasebenzisa i-24-yure ye-blood monitoring. Uxinzelelo lwegazi emini olungaphezulu kwe-130 ngaphezulu kwe-80 luxinzelelo lwegazi ebusuku, uxinzelelo lwegazi lwasebusuku olungaphezulu kwe-110 ukuya kuma-65 luxinzelelo lwegazi. Ngoko kutheni oku kubalulekile? Umyinge woxinzelelo lwegazi wehla ukuya malunga ne-15% ebusuku ngenxa yomba woxinzelelo lwegazi. Ukungaphumeleli kwehle uxinzelelo lwegazi ngelixa ulele ebusuku kunokubakho iingxaki ezinokuchaphazela umntu imini yonke. 

 

Ukuba isigulane sakho silala ebusuku, kufuneka sehle malunga ne-15% xa silele. Ukuba bane-non-dipping blood pressure, inxulumene ne-comorbidities. Zeziphi ezinye zezo zigulana kuxinzelelo lwegazi olungadipha? Ezinye zeemeko ezinxulumene noxinzelelo lwegazi olungadibaniyo ziquka:

• Isifo senhliziyo esixineneyo
• Izifo Zeenhliziyo
• Isifo seCerebrovascular
• Ukunqongophala kweNtliziyo yeCrows
• Ukungaphumeleli kwezintso okungapheliyo
• Ulwaphulo lweCerebral oluthe cwaka

I-Co-morbidities eNxulunyaniswe Noxinzelelo Lwegazi

UGqr. Alex Jimenez, DC, unikezela: Ezi zizifo ezinxulumene noxinzelelo lwegazi. Sonke siyavuma ukuba uxinzelelo lwegazi oluphezulu alulunganga kuzo zonke ezo meko. Ke xa ujonga amaqela abantu abahlukeneyo okanye ezinye izinto ezihambelanayo, uxinzelelo lwegazi olungatyibiliki luxhaphake kakhulu kubantu ababuthathaka kwi-sodium, abantu abanesifo sezintso, abantu abanesifo seswekile, abantu abashiye i-ventricular hypertrophy, abantu abane-hypertension ye-refractory. okanye inkqubo ye-nervous autonomic dysfunction kwaye ekugqibeleni, i-apnea yokulala. Ke, uxinzelelo lwegazi olungatshoniyo lunyusa unxulumano lwakho nomonakalo wentliziyo ongaphantsi. Kulungile, ukudipha uReverse kuthetha ukuba unoxinzelelo lwegazi kakhulu ebusuku kwaye ukunyuka okunxulumene kakhulu kunokuba ngexesha lasemini kunxulumene kakhulu nestroke esophayo. Kwaye ukuba unomntu onoxinzelelo lwegazi ebusuku, kufuneka uqale ukucinga ngezinto ezifana nemithambo yecarotid kunye nokwanda kwecarotid, ubukhulu be-medial yangaphakathi. Uqala ukucinga nge-hypertrophy ye-ventricular yasekhohlo kwaye unokuyibona kwi-EKG. Nantsi into esiyaziyo ngehypertension yasebusuku. Uxinzelelo lwegazi ebusuku luxinzelelo lwegazi lwasebusuku olungaphezulu kwe-120 ngaphezulu kwe-70. Inxulunyaniswa nokuqikelelwa okukhulu kokugula kwentliziyo kunye nokufa.

 

Ukuba une-hypertension yasebusuku, yonyusa umngcipheko wokusweleka kwi-cardiovascular disease ngama-29 ukuya kuma-38%. Kufuneka siyazi ukuba kwenzeka ntoni ebusuku xa silele, akunjalo? Ke, loluphi olunye uhlengahlengiso? Olunye uhlengahlengiso kukuqonda ukuba ukuphumla koxinzelelo lwegazi kulawulwa yinkqubo yakho ye-renin-angiotensin. Ukunyuka koxinzelelo lwegazi kulawulwa yinkqubo yakho ye-nervous enovelwano. Ke makhe sithethe malunga nendlela inkqubo yabo ye-angiotensin yezintso eqhuba ngayo uxinzelelo lwasebusuku, kwaye ucinga malunga nokuba ngawaphi amayeza abawathathayo. Unokutshintsha idosi yeyeza ibe kusebusuku. Ewe, uphononongo lubonise ukuba ukuba unoxinzelelo lwegazi ebusuku kwaye ungeyo-dipper, kungcono ukuba uthathe ii-ACE inhibitors, ii-ARBs, i-calcium channel blockers, kunye ne-beta blockers ezithile ebusuku ngaphambi kokulala. Kodwa iyavakala into yokuba awuyi kuhambisa i-diuretics yakho ebusuku, okanye uya kuba nokuphazamiseka kokulala.

 

Ukujongana noxinzelelo lwegazi lwasemini kunye nasebusuku

UGqr. Alex Jimenez, DC, unikezela: Ke ukuba asijongani noxinzelelo lwegazi lwemini nobusuku, kufuneka sithathele ingqalelo isiphumo somthwalo wegazi. Ithini i-avareji yoxinzelelo lwegazi lwakho lwemini kunye noxinzelelo lwakho lwegazi oluphakathi. Siyazi ukuba umthwalo wegazi kubantu abadala abancinci banoxinzelelo lwegazi malunga ne-9% yexesha. Ke intsingiselo yomthwalo we-systolic imalunga ne-9% xa ithelekiswa nabantu abadala, malunga ne-80% yomthwalo woxinzelelo lwegazi yi-systolic. Kwaye ke xa unomthwalo ophezulu we-systolic, uneengxaki ezininzi kunye nomonakalo wokuphela kwamalungu. Ke le nto sithetha ngayo kukunceda ukuchonga isigulana sakho esinoxinzelelo lwegazi; lithini ixesha labo? Yintoni phenotype yabo? Ngaba banoxinzelelo olukhulu kakhulu emini, okanye banoxinzelelo olukhulu ebusuku? Kufuneka sijonge ukuba yintoni enceda ukulungelelanisa oko.

 

Nali elinye inqaku, kuphela malunga ne-3.5% yabantu abanoxinzelelo lwegazi abanesizathu sofuzo. Kuphela yi-3.5% yabantu imfuza yabo ebangela uxinzelelo lwegazi. Amandla asezantsi kwe-matrix kunye nokuqaphela ezi patheni, akunjalo? Ngoko ujonga umthambo, ukulala, ukutya, uxinzelelo kunye nobudlelwane. Ke siyazi ukuba ezi zilinganisi zine zokuzimela zinceda ukugqiba uxinzelelo lwegazi. Siza kuvavanya inkqubo ye-angiotensin yezintso, umthamo weplasma apho babambe khona kulwelo oluninzi, umthwalo wetyuwa wesibini, kunye nokungasebenzi kakuhle kwe-endothelial. Ukungahambi kakuhle kuyo nayiphi na kwezi kunokukhokelela kuxinzelelo lwegazi. Besithetha ngenye into enokukhokelela kuxinzelelo lwegazi: ikhonkco phakathi kokumelana ne-insulin kunye noxinzelelo lwegazi.

 

Oku ngokomzobo kukunika umbono wonxibelelwano lwe-physiologic phakathi kokumelana ne-insulin kunye noxinzelelo lwegazi. Ichaphazela ukwanda kwethoni yovelwano kunye nokwandisa ibhalansi yenkqubo ye-renal-angiotensin. Ke masichithe imizuzu embalwa kwindlela ye-renin-angiotensin i-angiotensinogen ezantsi ukuya kwi-angiotensin yesibini. Sisebenzisa ezi enzymes ngokunika inhibitors kwi-angiotensin-converting enzymes kwizigulana zethu ezinoxinzelelo lwegazi. I-angiotensin ephakanyisiweyo emibini ikhokelela kwi-cardiovascular hypertrophy, ikhokelela kuxinzelelo lwesigaba sovelwano, ukunyuka kwevolumu yegazi, ulwelo lwesodium, ukugcinwa, kunye nokukhululwa kwe-aldosterone. Ngaba unokubuza malunga neempawu zebhayoloji zesigulana sakho? Ngaba unokubuza ukuba banyuse amanqanaba e-renin?

 

Khangela iMiqondiso

UGqr. Alex Jimenez, DC, unikezela: Ewe, unako. Unokujonga umsebenzi we-plasma renin kunye namanqanaba e-aldosterone. Kubalulekile ukwenza oku ukuba isigulana sakho sinoxinzelelo lwegazi kwaye asizange sifumane iyeza kuba kulapho i-nitrous oxide ibaluleke khona. Apha kulapho i-endothelial nitric oxide synthase yakho ikhona. Apha kulapho unoxinzelelo olupheleleyo kunye ne-hemodynamic. Yilapho ukutya okudliwayo kwe-arginine okanye indawo echaphazela i-nitric oxide idlala indima enjalo kwimpilo yolu luhlu lwe-endothelia. Ukuba uyibeka ndawonye ngandlel’ ithile, ngendlela engummangaliso, okanye ubuncinane kwiliso lengqondo yakho, iya kugubungela iinkundla zentenetya ezintandathu kumntu omdala oqhelekileyo. Yindawo enkulu yomphezulu. Kwaye izinto ezibangela ukungasebenzi kakuhle kwe-endothelial akuzona iindaba ezintsha kubantu kumayeza asebenzayo. Ukonyuka koxinzelelo lwe-oxidative kunye nokudumba zizinto ezimbini esizikhankanyileyo ezidlala isiphumo.

 

Kwaye emva koko, jonga amanye ala macandelo, i-ADMA yakho iphakanyisiwe kwaye ihambelana nokumelana ne-insulin. Yonke iqala ukwenza kunye kwi-matrix edibeneyo. Ke ujonga i-comorbidity enye kwi-cardiometabolic syndrome, kwaye ichaphazela enye i-comorbidity. Ubona ngequbuliso unxulumano phakathi kwabo okanye i-hyperhomocysteinemia, eyisiphawuli sekhabhoni enye-metabolism, okuthetha ukuba ujonge ukwanela kwe-folate, b12, b6, riboflavin, kunye naloo msebenzi wekhabhoni enye yemetabolism. Ke makhe sijonge ezinye zezi ziphawuli zomngcipheko asakhulayo ukuphucula kunye nomkhondo kwizigulana ezinoxinzelelo lwegazi. Masiphinde siyihlalutye iADMA kwakhona. I-ADMA imele i-asymmetric dimethyl arginine. I-Asymmetric, i-dimethyl arginine yi-biomarker ye-endothelial dysfunction. Loo molekyuli inqanda i-nitric oxide synthase ngelixa iphazamisa umsebenzi we-endothelial, kwaye kuzo zonke i-comorbidities ezinxulumene ne-cardiometabolic syndrome, i-ADMA inokuphakanyiswa.

isiphelo

Ke, njengokuphononongwa okukhawulezayo, i-L-arginine iguqulelwa kwi-nitric oxide nge-nitric oxide synthase, kunye nokwanela kwe-nitric oxide kukhokelela kwi-vasodilation. I-ADMA iyayivala le nguqulelo. Kwaye ukuba amanqanaba akho e-ADMA anyukile kwaye amanqanaba akho e-nitric oxide aphantsi, ke unciphise i-nitric oxide platelet aggregation yonyuka kwi-LDL oxidation. Izinto ezininzi ke zinciphisa i-nitric oxide okanye zinxulunyaniswa namanqanaba asezantsi e-nitric oxide, i-apnea yokulala, i-arginine yokutya ephantsi, iprotheni, ukungoneli kwe-zinc, kunye nokutshaya.

 

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